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Question:
I have a client who has no cartilage in his ankle joint. What exercises do I need to avoid and what exercises should I work on?
Answer:
When you refer to “ankle joint,” I would have to assume you are referring to the talocrural joint. This joint consists of the mortise formed by the talus sitting between the lateral malleolus of the fibula and medial malleolus of the tibia. The primary motion at this joint is plantar flexion and dorsi flexion.
Unless your client was born without cartilage, with the limited amount of information provided I am going to have to assume it is a result of trauma or prolonged misuse. In either event, the primary role of the cartilage at that joint is to facilitate the gliding movement of the talus for plantar flexion and dorsi flexion.
Therefore, I would be most concerned with limits to those motions. Typically, because of the shape of the joint and possible trauma to the ligaments, dorsi flexion is more limited than plantar flexion.
Normal dorsi flexion in a closed chain environment (i.e. foot on the ground) is critical to normal motion of the knee, hip and even spine. This is where you might consider looking initially, to be sure your client is not compensating up the kinetic chain.
Consider having your client’s ankle range of motion assessed by a physical therapist. In addition, evaluate your client’s ability to squat. If there is not normal motion in the talocrural joint, your client’s heel may come off of the floor as he squats, he may over pronate on that foot as he squats and/or he may feel a “pinching” in the front of the ankle the lower he goes down.
Sometimes to restore this motion, it initially can be expedited with manual mobilization by a physical therapist or chiropractor. One of your first priorities is to make sure your client is not compensating up the kinetic chain in any ground-based exercises.
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